The Efficacy of the Existing Interventions to Mitigate MNC - Term Paper Example

International Health Customer Insert His/Her Name Customer Insert Grades Course Customer Insert Tutors Name 8, June, 2012. Introduction Presently more than eleven million children die before their fifth birthday due to child related diseases that are mostly preventable; even more tragically almost all of these deaths occurs in developing countries with South-East Asia and Africa accounting for more than 75% of these deaths globally (Unicef.org. 2012; Zulfiqar, 2011). Indeed, in most cases about 80% of the time, neonatal mortality for instance which accounts for almost half of all child-related deaths is caused by just three conditions namely; preterm birth (27%), severe infections (26%) and birth asphyxia (23%) according to statistics adopted from the World Health Organization (WHO) database (2012). Besides neonatal mortality, the rest of child related deaths are caused by conditions such as diarrhea, pneumonia, malaria and other infections; all of which are preventable. Maternal mortality, which is the other indicator of the Maternal Neonatal and Child Health (MNCH) on the other hand still remains a significant occurrence and is similarly correlated to neonatal deaths in that the prevalence levels are skewed with most deaths occurring in developing countries as compared to developed countries (Unicef.org. 2012). For instance, 99% of all maternal deaths occur in developing countries where it is approximated that more than 800 women die every day due to pregnancy related complications caused by factors that are almost always preventable (WHO, 2012). Therefore, combined maternal, neonatal and child mortality rates accounts for probably 12 million cases annually globally. It is on this backdrop that this paper will evaluate the efficacy of the existing interventions that have been put in place to mitigate MNC mortality rates as well as explore new interventions that can be implemented to further address existing challenges. Background Unfortunately, despite immense investment towards health in general and particularly MNCH for several decades now, the current gains that have been made towards maternal and child health although laudable still remain dismal. Not surprisingly then, the achievement of the two millennium development goals (MDG) that are directly related to MCHN will not be achieved on time if the current trend is anything to go by. A look at the two millennium development goals (number 4 and 5) which touches on MNCH directly and which will be our interest in this paper indicates that much still remains to be done notably in developing countries. MDG number 4 for instance, which targets to reduce child mortality by two-thirds by 2015 from 1990 levels still remains a challenge in many developing countries and the indications are that this goal will not be met on time. To aggravate the situation even more, MDG number 5 which targets to improve maternal health by reducing maternal related mortality rates by three-quarters from the 1990 levels also remains unmet in most developing countries. Given that these two MDG goals are interrelated, it is to be expected that if child mortality rates still remain high, maternal mortality rates will subsequently remain high as well since factors associated with the former can also lead to the cause of the latter. It is from this basis that this paper will undertake a critical review of challenges related to maternal and neonatal health in specific, explore present interventions that have been put in place to overcome these challenges and finally investigate the impact that maternal and neonatal health has on child health prospectively. In this paper I will demonstrate that child health is in fact a function of maternal and neonatal health, and thus argue that the best interventions should be targeted towards promoting safe delivery and increasing access to reproductive health. Maternal Neonatal health (a) The impact of family planning on maternal health One of the earliest interventions that are normally put in place in order to achieve maternal health is provision and promotion of family planning methods, usually through contraceptives. It is estimated that a significant number of resulting pregnancies are in fact not intended or planned by those responsible, in other areas availability of contraceptives at the community level is even non-existent making it impossible to carry out family planning. Based on these realities it is not in doubt that provision of contraceptives alone can significantly reduce the rate of resulting neonatal, maternal and child mortalities. Indeed, United Nations Population Fund (UNFPA) lists various direct implications that investment in family planning programs can achieve towards promoting maternal health. (1) UNFPA estimates that regular access of contraceptives by women, most of whom are from developing countries can “cut by almost a third the number of maternal mortalities, from 356,000 to 105,000” (UNFPA, 2012). Much of this drastic reduction in maternal deaths would have been realized in developing countries if this was done. (2) Additionally, maternal health would improve given that "unintended pregnancies around the world would reduce by more than two thirds, from 75 million in 2008 to 22 million per year” (UNFPA, 2012). This will also has two other implications since it will also indirectly reduce child mortality rates as well, and also lead to improved child health. (3) Unsafe abortions, mostly arising from lack of contraceptives in the first place and one of the leading factors of maternal deaths “would decline by three quarters from 20 million to 5.5 million” (UNFPA, 2012). (4) Because of reduced conception rates, “the total number of women needing medical care for complications of unsafe procedures around the world would decline from 8.5 million to 2 million”, thereby overall improving the maternal health (UNFPA, 2012). This is mainly because contraceptives can be efficiently targeted towards women who are generally known to be at risk of maternal related complications due to factors such as lack of birth spacing, under age, abortions and so on, all of which are known to contribute to maternal deaths. Besides, use of contraceptive has been shown by several studies to be correlated with healthy family in general, and healthy family implies a healthy mother as well (Khan et al., 2006). Finally, contraceptive use has other indirect potential benefit to both the child and the mother in the long term and directly impacts on the health of the child, at least during the first five years when the child is most vulnerable to diseases. Despite the documentation of this direct association between maternal health and contraceptive use being common knowledge, family planning is ironically one of the least funded programs globally presently. In developing countries where lack of family planning is greatest and cause of significant number of maternal deaths, the Contraceptive Prevalence Rate (CPR) is at just 63%, and has for almost two decades now just improved by 8% from the 1990 level of 55% (Populationinstitute.org. 2012). This clearly as can be seen is a very low uptake of contraception use in developing countries and the cause of high rates in mortality rates for both mothers and children. This CPR also puts at risk the other component of MDG number five which envisions universal access to reproductive health care by 2015. However, what is even more alarming is that family planning programs globally have been receiving less funds year in year out since the start of this millennium in year 2000 and is probably one of the least funded health programs currently. During 2000-2008 period for instance the proportion of funds going towards family planning when compared to total health funding dropped by a whopping 5% to 3.2% (by 2008) from a high of 8.2% in year 2000 (Populationinstitute.org. 2012). The implications for this gradual reduction in funds going towards family planning are dire and some of the direct repercussions that are observable are “215 million women in developing countries with no access to modern contraception methods”, this is not to mention the indirect consequences (Populationinstitute.org. 2012). This then implies that family planning programs must be harnessed since it is one of the integral components towards attainment of maternal health, and a useful intervention for that matter. Leading causes of maternal deaths Nevertheless, there are other equally significant determinants of maternal health that must also be addressed, if maternal mortality rates are to be drastically reduced. For instance, it is estimated that as much as 80% of causes leading to maternal deaths are caused by just three conditions all of which are in fact preventable namely; hemorrhage (35%), hypertension (18%) and indirect causes (18) (Populationinstitute.org. 2012; UNDP.org, 2012). The figure below shows the rest of the factors attributed to maternal deaths such as abortion, sepsis and embolism. Figure 1 Unfortunately, like many other conditions related to health, all of these factors that are now known to cause maternal deaths mostly takes place in developing countries, notably Africa and South-east Asia for the simple reason that in these regions access to reproductive health, or indeed health services in general still remains dismal. If the quest of reducing by two-thirds maternal deaths by 2015 seems challenging based on current progress, then the achievement of the universal reproductive health by the same year as also outlined by MDG number five is clearly daunting. In fact, the only way to realize tangible and rapid gains as far as maternal health is concerned is by promoting access to health in general, and then reproductive health to all mothers living even in the most remote areas so as to achieve 100% coverage of health services provision. Presently, access to reproductive health in developing countries (Africa & Asia) is pegged at about 70%, and even this coverage is not comprehensive yet (UNDP.org, 2012). A huge proportion of mothers in these regions are still unable to access the full benefit of reproductive health services, thereby putting themselves at risks of dying from the above listed conditions. The relationship between maternal health and child mortality rates Children aged under five years mortality rate, is one of the most significant indicators of MNCH. Presently, close to eleven million children die globally before they reach five years of age, again most of these deaths (two-thirds) occur in developing countries (Unicef.org, 2012). Approximately half of these deaths (41%) are neonatal deaths which have a direct bearing to the health of the mother (Unicef.org, 2012). Even, the rest of the leading causes that are attributed to children under five mortality rates are mostly preventable and are conditions that are generally not serious causes of deaths since they are treatable such as diarrhoeal diseases, pneumonia, measles and malaria (Unicef.org, 2012). It is only HIV AIDs which accounts for just 2% of child mortality that is in fact not treatable. The figure below shows the leading causes of children under five mortalities globally. Figure 2 Malaria alone for instance accounts for 300 million morbidities every year worldwide, majority of this cases occurring in developing countries; 1 million of these persons diagnosed with malaria eventually dies, 90% of the time happening in Africa mainly among children aged below five years and pregnant mothers who accounts for more than half of all malaria related deaths taking place (Unicef.org, 2010). As a result, when combined malaria alone significantly impacts on MNCH in general when you consider it contributes to 8% of all under-five years of age child related deaths. In Africa, due to its high malaria incidence levels, this prevalence is even higher. What is more is that for more than five decades now malaria is still the leading cause of deaths in both children under five years of age as well as pregnant mothers in Africa; in fact, 20% of all child related deaths that occur among children aged less than five years are directly as a result of malaria epidemic (Unicef.org, 2010). The highest proportion of hospital admissions and clinical consultations that take place in Africa are largely as a result of malaria infection; as high as 30% cases are diagnosed with the disease while more than 25% of admissions are malaria related in endemic countries of Sub-Saharan Africa (Unicef.org, 2010). Overall even the least affected countries in Africa which are not located in tropical or subtropical regions where malaria prevalence is at its highest indicates ever increasing prevalence rate for malaria. This is a very high disease burden that adversely impacts on MNCH. All of these diseases can effectively be prevented and all these deaths avoided through implementation of maternal health programs as the first line of defense against these conditions. This is because if women have access to maternal health before and after delivery diseases such as diarrheal, measles, pneumonia and malaria can be effectively be diagnosed and treated or prevented through early immunization at any health facility by a skilled health worker. Transmission of HIV AIDs from mother to child on the hand is also effectively prevented through current medical interventions and should also not be a cause of child mortality. Finally, neonatal deaths which are the leading cause of child mortality rates can effectively be prevented through provision of reproductive health services to women who are at the greatest risk, mostly from developing countries. Conclusion It is clear from the above analysis that developing countries poses the greatest hurdle towards universal attainment of not only maternal neonatal health, but also child health as well. Indeed, not only are the developing countries lagging behind towards attainment of these two MDGs (number 4 and 5), but the same countries in fact are unlikely to meet the target set for the rest of the six MDGs. Consequently, based on the nature of existing challenges that hampers attainment of MNCH, it is clear that the most effective interventions should have, and must now be directed towards these target group that continue to be at the greatest risk. Indeed, current evidence indicates that necessary and adequate investments that should have been directed towards MNCH was never made or has been in decline for the last decade or so. As has been demonstrated, investment towards family planning program which is a key integral component to MNCH in general and specifically to maternal health, has for years now remained underfunded. The implications for lack of appropriate interventions and low funding for very critical programs has proved disastrous and is what has led to the current dismal MNCH situation globally, which is at its worst in developing countries. These not well thought interventions or lack of any interventions at all for that matter is what has led to the present situation whereby the maternal, neonatal and child mortality rates is still unacceptably high, and disproportionally distributed along geographical regions. References Khan, K. Wojdyla, D., Say, L., Gülmezoglu, AM & Van, L. 2006. WHO analysis of causes of maternal death: a systematic review. Lancet, 1: 1066-74. Populationinstitute.org. 2012. From 6 Billion to 7 Billion: How population growth is changing and challenging our world, viewed 8 June 2012, . Unicef.org. 2012. Goal Reduce Child Mortality, viewed 6 June 2012, < http://www.unicef.org/mdg/childmortality.html>. Unicef.org. 2010. The Africa malaria report, viewed 8 June 2012, . UNFPA.org. 2012. Millennium Development Goal 5: Improve Maternal Health, viewed 8 June 2012, . UNDP.org. 2012. Improve maternal health, viewed 8 June 2012, . World Health Organization. 2012. Maternal mortality, viewed 8 June 2012, . Zulfiqar, B. 2011. Global Maternal, Newborn and Child Health: challenges and opportunities. Conference Paper, The Aga Khan University Pakistan, viewed 8 June 2012 . Read More